Axa ppp healthcare

[Mrsinghd]

Hi all.

My father had a cardiac operation and was under the impression that axa ppp healthcare would be paying for it as he had a policy with them.

 

After the operation axa ppp healthcare turned around to say that it would not be covered

as my father went in to the doctors once (around 4 years before) because he complained of chest discomfort due to some gas.

 

 

This turned out to be utter nonsense and non related and we thought the claim would be upheld.

 

Axa then turned around and said he would now not be covered as he may have been diabetic.

 

We wrote to axa regarding this and they said they would refund the premium, needless to say we were not happy.

 

We then went to the financial ombudsman for an impartial view.

 

The FOS said we had been mis-sold the policy and had my father have known he would not have been covered

he would not have had taken out the policy in the first place.

 

The adjudicator then said that in her opinion axa should refund the premium + 8% interest due to a missell occurring.

 

We are thinking of going to court with this,

I have looked around online and axa seem to have a habbit of finding ways not to pay out,

with alot of people complaining of the same thing happening to them.

 

 

We have a evidence on a cd whereby 2 of the employees of axa are laughing at my fathers condition saying

"thank god theres a chance he may be diabetic otherwise we might have to pay"

needless to say I was not happy after hearing this.

 

I think if all the genuine people axa healthcare have refused cover got together and took them to court

we would have a good chance of winning due to the way they conduct business,

a quick google search of axa healthcare reviews shows all reason this company needs to be taken to court.

 

I'm certainly not one to back down from this, just because I believe axa healthcare has refused genuine people

such as my father after taking their premiums, and if they complain axa healthcare just refund the premium,

but as majority will not they will not even get this back.

I genuinely believe had I not looked into this,

my father would be screwed over by axa ppp which is unfair.

 

Edit: the amount of the operation from a bill we recieved from the nhs was £4500 ish

and I don't think this covers the doctors fee's either.

 

1. My question is

can a company such as axa ppp healthcare mis-sell a insurance policy then when it comes to pay out,

turn around and refund the premium even if they mis-sold it in the first place?

 

2. What would be the next route,

i.e. We have been to the ombudsman,

where do we go next i.e. Small claims court?

 

Thank you for reading.

[dx100uk]

if you were to put every payment in this spreadsheet

StatIntSheet v101.xls

 

 

on the day it was paid in

each on their own row

what does this come too?

[Mrsinghd]

if you were to put every payment in this spreadsheet

 

 

 

on the day it was paid in

each on their own row

what does this come too?

Sorry do you mean payment to Axa ppp healthcare?

If so it would be around £800 which is measly considering the hospital bill alone is £4500+

[dx100uk]

yes but if you follow what the fos say:

The adjudicator then said that in her opinion axa should refund the premium + 8% interest due to a missell occurring.

 

 

that means from the date of each payment

you get 8%PA back as well.

 

 

now this could be worth a lot of money

 

 

but we don't know the dates but you do and you can use the spreadsheet to workout the redress.

 

 

no it wont prob be £4500 bt the older each payment

the more int it is worth.

 

 

just an idea but we don't know the dates

 

 

dx

[Mrsinghd]

yes but if you follow what the fos say:

The adjudicator then said that in her opinion axa should refund the premium + 8% interest due to a missell occurring.

 

 

that means from the date of each payment

you get 8%PA back as well.

 

 

now this could be worth a lot of money

 

 

but we don't know the dates but you do and you can use the spreadsheet to workout the redress.

 

 

no it wont prob be £4500 bt the older each payment

the more int it is worth.

 

 

just an idea but we don't know the dates

 

 

dx

 

Comes to around £800, just put in all of the dates. Really not looking to go down this route, I genuinely believe there must be another way

[unclebulgaria67]

If it was NHS, why did it cost you £4500

 

I think you are saying that AXA should have paid this and not that you had to pay the NHS.

 

If you want to pursue this you need Doctors evidence that the medical conditions raised by AXA are not relevant to either the purchase of the policy or the medical issue being claimed for.

 

My theory is that the FOS are looking at miss selling, so you get money back. Had you had a bill from the NHS which you had to pay, then they may have looked more at the claim. The FOS tend to only address losses you actually suffered.

[Mrsinghd]

If it was NHS, why did it cost you £4500

 

I think you are saying that AXA should have paid this and not that you had to pay the NHS.

 

If you want to pursue this you need Doctors evidence that the medical conditions raised by AXA are not relevant to either the purchase of the policy or the medical issue being claimed for.

 

My theory is that the FOS are looking at miss selling, so you get money back. Had you had a bill from the NHS which you had to pay, then they may have looked more at the claim. The FOS tend to only address losses you actually suffered.

 

Yes I had a bill from the hospital for £4500 as it was done privatley.

As the procedure was fast tracked

[unclebulgaria67]

Yes I had a bill from the hospital for £4500 as it was done privatley.

As the procedure was fast tracked

 

OK so your course of action is to enforce the contract by taking AXA to court if necessary. You don't want the policy cancelled and premiums refunded.

 

You need to identify whether there was any non disclosure when the policy was taken out, that would have affected AXA issuing the policy. If AXA would have issued the policy, it is a medical technicality as to whether any pre existing medical issues had any affect on the claim being made. This is where you need a medical opinion from Doctors about the issues AXA raised e,g diabetes. If you can get a written opinion, then send AXA CEO a letter before action with the opinion advising that unless AXA resolve the claim, a court claim will be issued against them. You can use the MCOL online court claims system to start it if need be. If you are not confident doing this, find a Solicitor.

[Mrsinghd]

OK so your course of action is to enforce the contract by taking AXA to court if necessary. You don't want the policy cancelled and premiums refunded.

 

You need to identify whether there was any non disclosure when the policy was taken out, that would have affected AXA issuing the policy. If AXA would have issued the policy, it is a medical technicality as to whether any pre existing medical issues had any affect on the claim being made. This is where you need a medical opinion from Doctors about the issues AXA raised e,g diabetes. If you can get a written opinion, then send AXA CEO a letter before action with the opinion advising that unless AXA resolve the claim, a court claim will be issued against them. You can use the MCOL online court claims system to start it if need be. If you are not confident doing this, find a Solicitor.

 

 

Sounds good.

What do you mean by a non disclosure? If axa had known my father may have diabetes they still would have given him the policy but it would be a mis-sell which is what the fos said.

I'm really confused on what to do so thanks for that information, I can assure you, you have added light to the end of the tunnel.

[unclebulgaria67]

Sounds good.

What do you mean by a non disclosure? If axa had known my father may have diabetes they still would have given him the policy but it would be a mis-sell which is what the fos said.

I'm really confused on what to do so thanks for that information, I can assure you, you have added light to the end of the tunnel.

 

Non disclosure = not advisng AXA of all known medical history they asked for before he took out the policy.

[Mrsinghd]

Non disclosure = not advisng AXA of all known medical history they asked for before he took out the policy.

 

I see. Do you have any clue where I can get the contact details of Axa ppp healthcare ceo? So i can issue that letter before action

[caro]

Was this an emergency operation? It's just I get Axa PPP Healthcare through work, and have been told you need authorisation for treatment before you can get it.

 

I realise that doesn't help but might be worth bearing in mind.

 

How long has your father been with Axa?